The CORE-EM Alliance (COalition for REsearch in Emergency Medicine) brings to SIREN six highly experienced research infrastructures, each with their own 5 spokes, partnering to create an innovative single super hub in the 10-hub SIREN network. The goal of CORE-EM is to provide a highly functioning infrastructure for rapid implementation and high quality performance of large pragmatic clinical trials for a wide variety of emergency conditions including, neurology, cardiovascular, respiratory, hematologic, and trauma related emergencies. Our model is remarkably flexible and efficient, as we can be as lean as six independent sites, or have the ability to rapidly expand to 30-plus enrolling sites. The CORE-EM leverages veteran leadership and experienced research teams with a long history of prior successful collaboration and exemplary clinical trial performance and provides SIREN access to an impressively diverse patient population, spanning large geographic regions within the Southern and Eastern United States. The CORE-EM Alliance will easily be capable of implementing four or more simultaneous large (>1,000 patient), simple, pragmatic trials in the Emergency Department (ED) and out of hospital settings. CORE-EM is committed to being an extraordinary partner for SIREN with a focus on conducting rigorous trials and assessments of novel therapeutic interventions in an aim to improve the lives of our patients.